California's $12 Billion Stem Cell Agency and Fresh Ruckus over Conflicts of Interest

The appointment of a new member to the governing board of California's $12 billion stem cell research program triggered additional comment and criticism today concerning conflicts of interest at the agency. 

The matter involves Larry Goldstein, a well-known scientist at UC San Diego, who has received $22 million from the California Institute for Regenerative Medicine (CIRM), the formal name for the stem cell agency. Goldstein's employer has received $232 million. 

Marcia Darnovsky
CGS photo

"Conflicts of interest at CIRM have been a major concern since the agency was founded, as pointed out by observers including the Institute of Medicine (IOM) and the Little Hoover Commission, California's independent oversight organization," said Marcy Darnovsky, executive director of the Center for Genetics and Society in Berkeley, Ca., which has long opposed CIRM.  

"Proposition 14, which just last fall gave CIRM another $5.5 billion of public funding, should have been a chance for the agency to turn over a new leaf, but it made none of the changes that could have addressed the agency's built-in conflicts or other structural problems.

"Now CIRM has accepted a board member who has personally received some $22 million in CIRM grants, and whose institution has received far more. It appears that CIRM will continue to flout basic principles of good governance, despite being a public agency wholly funded by public dollars. This is a real and ongoing problem."

Last September, Capitol Weekly, California's respected government and political news service, carried an analysis of CIRM awards and their relationship to board members. It showed that 80 percent of the $2.7 billion awarded by CIRM has gone to institutions with links to past and present members of the CIRM board. 

The agency's 35 directors are barred from voting on specific awards to their institutions. However, they set the rules, scope and direction for the awards.

UC Davis stem cell scientist and blogger Paul Knoepfler, who supports the stem

Paul Knoepfler
UCD photo

cell agency, said in a comment this morning carried on the first item on this subject on the California Stem Cell Report,  

"I'm sure that Larry will do an excellent job on the board, and he brings a unique depth of knowledge on stem cell research. However, along the lines of what Aaron said as quoted in the piece, at the very least the appointment presents some challenges of perception of the agency."

Knoepfler's reference is to Aaron Levine, a Georgia Tech biomedical research policy expert who served on the IOM panel that conducted a $700,000 study of CIRM and recommended major changes in its governance and conflict of interest procedures. Levine told the California Stem Cell Report, 

“Larry Goldstein is, in many ways, an inspired choice for the CIRM board. He is a well-regarded stem cell scientist and former CIRM grantee with administrative experience and demonstrated interest in public policy. On the other hand, CIRM has, at the very least, a perception problem with conflicts-of-interest and appointing a former grantee to the board so soon after the passage of Proposition 14 seems to suggest that this challenge will persist.”

“More broadly, conflict of interest concerns reflect the structure of the CIRM Board dating back to Proposition 71 in 2004 and the broader challenge facing many organizations of recruiting interested, qualified, and independent board members. CIRM has taken a number of steps to help address conflicts of interest since the IOM report was published many years ago, but I would have liked to see the board structure adjusted as part of Proposition 14 to introduce more independence into the oversight structure and further address these concerns.”

CIRM was running out of money last year and was set to close its doors until voters approved Proposition 14, which provided $5.5 billion more and significantly expanded the scope of the agency. 

CIRM had an opportunity to deal with conflict of interest concerns during the formulation of the ballot measure in discussions with the sponsor of the measure, Robert Klein, a millionaire developer in Palo Alto. Klein also directed the writing of Proposition 71 in 2004 and served as CIRM's first chairman after writing into the initiative qualifications for the chair that applied uniquely to him.

The California Stem Cell Report asked Klein this morning whether he had made a recommendation to any party that Goldstein, who is co-chair of a scientific advisory panel to Klein's stem cell advocacy group, be appointed to the CIRM board. Klein replied in an email this morning:

"No. I learned of the appointment after the fact. Dr. Goldstein will be an outstanding board member. Given that he has closed his lab at UC San Diego and he is no longer conducting stem cell research, his extraordinary research record on neurodegenerative diseases and his experience in previously competing for CIRM grants will provide the board with important insights in advancing the search for therapies that are devastating to the brain, the body’s neurological system, and many other disease areas. 

"The State of California’s stem cell therapy development efforts and science generally will benefit greatly by Dr. Goldstein’s sacrifice of the remaining years he could have conducted scientific research, in favor of this new commitment to public service on the CIRM board, that will benefit patients everywhere." 

Lawrence Goldstein in lab at Sanford
Consortium, UCSD photo

Goldstein is barred by CIRM rules from applying for grants. The agency said yesterday that Goldstein has stepped away from his research with the exception of one project. 

(Update: CIRM told the California Stem Cell Report on Monday that it was speaking for Goldstein in its comments. Goldstein confirmed that in an email and did not respond otherwise.) 

It is technically possible today to make changes in the law dealing with conflicts at CIRM and the composition of its board. However, those would require a super, super-majority vote (70 percent) of both houses of the legislature and the signature of the governor, a politically difficult task. 

Recipient of $22 Million from California's Stem Cell Program Named to Its Board

Larry Goldstein, UC San Diego video

Larry Goldstein, a well-known stem cell researcher at the University of California, San Diego who has received nearly $22 million in awards from the California stem cell agency, today was named to its governing board.

It was the first time in the history of the 16-year-old agency that a scientist who has received agency awards has been appointed to the board of the California Institute for Regenerative Medicine (CIRM), as the stem cell agency is officially known. 

Goldstein's appointment raises once again questions involving conflicts of interest at the agency. Since its inception, CIRM has awarded $2.7 billion to California researchers and enterprises, including UC San Diego. Eight out of every ten dollars has gone to institutions with links to past or present CIRM board members, according to an analysis by the California Stem Cell Report. 

Conflict of interest issues have dogged the agency since before voters created it in 2004. In a report in 2012 commissioned at a cost of $700,000 by CIRM itself, the prestigious Institute of Medicine (IOM) said, 

“Far too many board members represent organizations that receive CIRM funding or benefit from that funding. These competing personal and professional interests compromise the perceived independence of (the CIRM governing board), introduce potential bias into the board’s decision making, and threaten to undermine confidence in the board.” 

The IOM said the composition of the board, which is called the Independent Citizens Oversight Committee (ICOC) makes it neither “independent” nor capable of  “oversight.” 

In response to a question, Kevin McCormack, senior director of CIRM communications, said, 

"Larry is no longer involved in any active CIRM awards and has stepped away from his research work, with the exception of one project for which he does not intend to seek CIRM funds.

"He brings a wealth of knowledge to the board and a different perspective as a leading stem cell scientist and former CIRM-funded researcher. As for conflicts, he is precluded from voting on any applications and cannot even participate in the discussion of applications submitted by UCSD."

While members of the CIRM board cannot vote on specific applications involving their institutions, they set the rules for the grant competition and approve "concept plans" for new grant rounds. Those rounds can and do benefit board members' institutions. UC San Diego has received $232 million in total funding from the agency, making the campus the third-largest recipient.  

CIRM provided $43 million to help create the Sanford Consortium for Regenerative Medicine in La Jolla, which involved UC San Diego and other research institutions, all of which have been represented on the CIRM board.  Goldstein was the founding scientific director of the consortium.  

Goldstein, as a member of the CIRM board, is barred from applying for additional funding, CIRM said in response to a question.  

Aaron Levine
Georgia Tech photo

Queried by email, Aaron Levine, a member of the IOM panel that studied the stem cell agency and an expert in biomedical research policy at Georgia Tech, said, 

“Larry Goldstein is, in many ways, an inspired choice for the CIRM Board. He is a well-regarded stem cell scientist and former CIRM grantee with administrative experience and demonstrated interest in public policy. On the other hand, CIRM has, at the very least, a perception problem with conflicts-of-interest and appointing a former grantee to the Board so soon after the passage of Proposition 14 seems to suggest that this challenge will persist.”

“More broadly, conflict of interest concerns reflect the structure of the CIRM Board dating back to Proposition 71 in 2004 and the broader challenge facing many organizations of recruiting interested, qualified, and independent board members. CIRM has taken a number of steps to help address conflicts of interest since the IOM report was published many years ago, but I would have liked to see the board structure adjusted as part of Proposition 14 to introduce more independence into the oversight structure and further address these concerns.”

Proposition 71 is the ballot initiative that created CIRM in 2004 with $3 billion in state bonds. When the money ran out last year, voters approved Proposition 14, which saved the agency with $5.5 billion more. The total cost of the agency by the time the money runs out again is estimated to be $12  billion because of the interest expense of the bonds. 

Proposition 14 also expanded the board from 29 to 35 members, creating an increased likelihood of conflicts of interest. 

Bob Klein
California Stem Cell Report photo

A longtime observer of the agency and supporter of stem cell research, who must remain anonymous, was "quite
distressed" by the Goldstein appointment. "Don't they have any sense of what's appropriate," the person said. "He has benefitted in so many ways and is so intertwined with Bob Klein." 

Klein is the Palo Alto developer who crafted Proposition 14 and 71 and contributed millions to the ballot campaigns. Goldstein serves as co-chair of the scientific advisory board of Klein's stem cell advocacy group, Americans for Cures. 

In its news release, CIRM Chairman Jonathan Thomas said, 

“I have known Larry for many years and have nothing but the highest regard for him as a scientist, a leader, and a great champion of stem cell research. He is also an innovative thinker and that will be invaluable to us as we move into a second chapter in the life of CIRM.”

Reports filed by Goldstein on his research can be found on this CIRM web page and by clicking on the description of each award. He was appointed by UC San Diego Chancellor Pradeep Khosla and replaces David Brenner, dean of the UC San Diego Medical School, who has served two terms on the CIRM board. . 

Hundreds of California Scientists Eyeing $182 Million from Golden State Taxpayers

Hundreds of California stem cell researchers this week took part in an online exploration of the new, $182 million research plans of the state's newly refinanced efforts to develop therapies for afflictions ranging from cancer to incontinence. 

Their questions ranged from the quite technical to how to comment during the formulation of a new strategic plan for the California Institute for Regenerative Medicine (CIRM), the official name of the stem cell agency. 

CIRM is in the process of figuring out how to spend a total of $5.5 billion approved by voters last fall. The cash will fuel research for about another 11 years. At that point, CIRM funding will terminate unless another source of financing is developed. 

The agency was created in 2004 by voters who allotted it $3 billion in borrowed money. By the time the money runs out, CIRM will have cost taxpayers an estimated $12 billion, which includes interest on the state bonds.  

This week's webinar dealt with the agency's plans to award $182 million -- the first bite into the new $5.5 billion -- over the next six months for basic, translational and clinical research. On Thursday, Gil Sambrano, vice president of portfolio development review, laid out the plans that were approved last month by the CIRM governing board. He answered a number of questions during the session, which was viewed by more than 350 participants. Since then, the recording of the session has attracted an additional, 50-plus viewers.  (To see the session, click on this sentence.) 

CIRM began making awards in September of 2005, and it has delivered cash to more than 900 recipients. Many have received more than one award. 

The first deadline for clinical applications in the latest round of funding is the last business day of this month. The deadline for translational applications is 2 p.m. PST Feb. 18. The deadline for the basic research "Quest" round is 2 p.m. PST March 18. 

Looking for Some Research Cash? $182 Million on Table in California; Briefing Thursday on How to Get It

California's $12 billion stem cell program is entering a new phase that will affect patients and researchers alike, and it is planning a show-and-tell this Thursday for the curious.

"With the voter approval of Proposition 14 CIRM is about to start a new chapter in its life. Because we are always trying to improve the way we operate, always trying to be better, there are going to be changes in the way we do things. Some of those changes are in the way we fund research, and the kinds of projects we are going to fund," the agency said in an announcement last week. 

Gil Sambrano, CIRM photo

Addressing many of those matters will be Gil Sambrano, the stem cell agency's
vice president of portfolio and review. Sambrano has been at CIRM (the California Institute for Regenerative Medicine) for years. He is in charge of the application review process, among other things. (Update: Here is a link to a video of the presentation.)

The CIRM session is aimed primarily at researchers and is expected to deal with some changes dealing with making CIRM-funded data more open along with the new diversity requirements in applications dealing with both potential patient populations and lab/research staffing. 

CIRM plans to award $182 million in the next six months. Based on discussions and action last month by the CIRM board, it would behoove applicants to be well-informed about the details of the new requirements and how they will affect the scoring of grant applications. 

Here are links to the specifics on the changes: discovery/basic research, translational and clinical.

Here are CIRM instructions for joining the webinar that begins at noon PST on Thursday. The Zoom address is https://cirm-ca.zoom.us/s/92287515387. 

Other methods: Phone one-tap, US: +16699006833,,92287515387# or +13462487799,,92287515387#, or join by telephone (for higher quality, dial a number based on your current location) US : +1 669 900 6833 or +1 346 248 7799 or +1 253 215 8782 or +1 301 715 8592 or +1 312 626 6799 or +1 929 205 6099; Webinar ID 922 8751 5387, passcode 210107.

Going Dark for the Holidays

 The California Stem Cell Report will be dark for the holidays until about Jan. 4. If you have last-minute gifts to give, don't forget "California's Great Stem Cell Experiment," a great gift for anybody above age 13 and some below that the age, even many of our dear readers. 😉

California's Quest for Stem Cell Therapies: $5.5 Billion Reboot Kicked Off Today

California's ambitious stem cell agency today launched itself on a new, $5.5 billion journey, approving a plan to hand out $182 million to researchers by the middle of next year and beefing up its efforts to bring equality to therapies and scientific labs.

The moves came courtesy of Proposition 14, the ballot initiative that saved the financial life of the California Institute for Regenerative Medicine (CIRM), as the agency is officially known.  Just 12 months ago, CIRM was dealing with its possible demise as it was running out of the $3 billion that voters gave it in 2004. 

Proposition 14 sets the agency, which currently has only 33 employees, on a sweeping course that extends its work into areas such as mental health and "aging as a pathology." The agency's new, 17,000-word charter also provides up to $155 million for work dealing with affordability and access to possible stem cell therapies. 

CIRM was created 16 years ago by another ballot initiative following a campaign that raised voter expectations that stem cell therapies were right around the corner. The agency has yet to help finance a stem cell therapy that is approved for widespread use by the federal government, although CIRM is backing 68 clinical trials, a number that was considered unimaginable in 2004, the year the agency was born. 

During its online meeting today, the agency's governing board approved, as expected, a $182 million plan to make 36 awards during the next six months. It calls for $100 million for clinical work, $22 million for basic research and $60 million for translational research, which involves attempts to move discoveries into the clinical stage, the last stop before they are approved for general distribution. 

A call for applications is expected to be posted soon. 

The board took its first step to address the affordability and access issues identified by Proposition 14. Eight persons were named to CIRM's new Affordability and Access committee. It will be led by CIRM's vice chair, Art Torres, a former state legislator and who also serves on the board of Covered California, a state body designed to deal with affordability issues in connection with the federal Affordable Care Act. More persons are expected to be named to the affordability committee next month. 

The CIRM board approved changes in how it evaluates applications for awards to require scientists to specifically address diversity and equity issues. Under its new rules, applications will be scored on how well the research deals with underserved communities. Applicants will also be scored on the diversity of their research teams. 

The agency's new operational budget calls for the hiring of 10 more employees between now and the end of June, ranging from a vice president for science to an administrative assistant. Job listings are expected to be posted soon. 

CIRM Chairman Jonathan Thomas laid out some details for crafting a new strategic plan for the next five years. It includes action on the plan by the end of June, which will mean that requests for applications will be issued soon thereafter.  The June date has been moved up from later in the summer.

The public and researchers will be able to weigh in with comments and suggestions during the development of the plan. 

Today's session stood in sharp contrast to the agency's first meeting this month in 2004, just after the voter approval of the ballot measure that created CIRM.  The fledgling agency did not have a single employee. It had no bank account, no offices and no phones. Spectators, interested parties and news reporters, nonetheless, crowded into the CIRM board's first meeting. Major stories appeared in the media throughout the state. 

Today, CIRM's online session was watched by only about 30 to 40 persons, most of whom were likely associated with the agency itself. And the meeting drew virtually no media attention.

More Information Available This Morning on Future Direction of $12 Billion, California Stem Cell Program

California's $12 billion stem cell research program, which is embarking on a major new pathway, has posted additional information online that provides some clues to its direction for the next five years. 

The information comes in the form of 33 pages of slides to be used today at a daylong, public meeting of the agency's governing board. The slides were created by Maria Millan, president of the California Institute for Regenerative Medicine (CIRM), as the agency is formally known, and other top executives of the enterprise. 

While the slides need considerable explanation, which will be forthcoming later today, they provide a start for those seeking to understand how the 16-year-old agency is planning to spend $5.5 billion in the Golden State over the next decade or so. 

Beyond the 33 pages of slides, other information is being offered as well that deals with a $182 million awards budget for the next six months and new requirements for sharing research data and increasing diversity.  

Still missing is information on the launch of the agency's new effort at dealing with affordability and access questions involving stem cell treatments, a new task created by Proposition 14, the ballot initiative that saved CIRM's financial life. 

The agenda for Monday's meeting contains instructions for participating in the online meeting. Written comments are always useful as well as oral presentations. Written material can provide needed backup for the briefer oral comments and are directly in front of CIRM directors and staff. Comments should be emailed to kmccormack@cirm.ca.gov.

The session starts at 9 a.m. PST today.

Needs of the Underserved: California Scientists Seeking Millions for Stem Cell Research Will Need to Measure Up

Directors of California's $12 billion stem cell agency tomorrow are expected to require scientists seeking hundreds of millions in research dollars to specifically address the needs of underserved communities.

If the researchers fail to do so, their applications will receive a score that reflects that shortfall. The immediate impact will fall on scientists who apply for funding from the $182 million expected to be handed out during the next six months.

Below is language from a "concept plan" before the board. This particular version comes from the plan that applies to basic research applications. Nearly identical language is also contained in plans for the translational and clinical rounds.

All of the concept plans can be found on agenda for the meeting, which also contains instructions for participating in the online meeting, which is open to the public. Written comments are always useful as well as oral presentations. Written material can offer needed backup for the briefer oral comments and are directly in front of CIRM directors and staff. Comments should be emailed to kmccormack@cirm.ca.gov.

The new language is in red. The strike-throughs indicate language to be removed. 

“Addressing the Needs of Underserved Communities

in CIRM-Funded Projects

“All applicants for the DISC2 program will be required to provide a statement describing how their overall study plan and design has considered the influence of race, ethnicity, sex and gender diversity. 

"Applicants should discuss the limitations, advantages and/or challenges of their research proposal in developing a product or tool that addresses the unmet medical needs of the diverse California population, including underserved racial/ethnic communities. Examples include use of models and tools that account for population diversity (e.g. HLA types, gender, genomics data, cell models). 

"Applicants should also address how the research team has or will incorporate diverse and inclusive perspectives and experience in the implementation of the research project. 

"The GWG and CIRM’s governing board will evaluate consider these statements as a review criterion in their evaluations and in making funding recommendations. Priority will be given to projects with the highest quality plans in this regard."

Quote of The Day

 "The first COVID-19 vaccine is not expected to be ready for clinical trials before the end of the year." From the journal Infection, Genetics and Evolution, April 19, 2020. 

Speak Up: Time to Help Shape California's $12 Billion Stem Cell Future

One of the excellent features of California's $12 billion stem cell program has little to do directly with science. The feature does not deal with petri dishes, genetic manipulation or microscopes.

It has a lot to do, however, with the stem cell agency's responsiveness to the public. It involves the persons behind the test tubes and even the Big Pharma companies that are the key to bringing stem cell therapies into widespread use. 

What we are talking about is fundamental to building trust in the California Institute of Regenerative Medicine (CIRM), as the stem cell agency is officially known, and whether CIRM can sustain itself beyond the date when its money runs out again in a decade or so. 

On the surface, it's a simple matter: the ability of the public, scientists and businesses to weigh in on how CIRM spends its next $5.5 billion -- the amount that the people of California are borrowing to pay for the agency's forays. 

Next Monday represents a first-rate opportunity for the public and the myriad interested parties to show up and speak up, both to the board that governs CIRM and its top executives. Some of the matters on the table at Monday's CIRM directors' meeting are, in one form or another:

• Should CIRM spend $100 million for clinical work over the next six months and only $22 million on basic research? 
• Should it change its diversity requirements to require more awards to a more diverse group of scientists?
• Should it require wider research data sharing to improve the quality of work across the field or should it cosset CIRM-financed findings to shield intellectual property?
• How should the state spend up to $155 million to improve stem cell treatment affordability and patient access to therapies and clinical trials? Does such an effort actually represent an unnecessary subsidy to the businesses involved?

Anybody who desires to do so can participate in the CIRM board meeting, which will be online. Questions can be asked. Suggestions can be made. Complaints can be aired. 

The session represents the first big step into CIRM's new world of Proposition 14, the ballot initiative the provided the new, $5.5 billion in bond funding. The measure  also set CIRM on a wider course that offers fresh opportunities that are not without challenges.  

Deciding how to spend $5.5 billion is not a minor matter. It is tiny, however, compared to the dense processes used by another government research organization -- the 27 branches of the National Institutes of Health and their multitude of advisory bodies. In contrast, California's stem cell program is wide open, transparent and accessible to the people most affected. 

What happens beginning Monday and over the next year will fundamentally shape the success or failure of California's stem cell program, the largest such state effort in the nation and the first in California's history. 

CIRM stands open to influence -- for better or worse -- by patients, the general public, researchers and companies that have received nearly $3 billion over the last 16 years. It is now up to all those folks and more to speak up and help CIRM in its efforts to bring to market the much-heralded stem cell therapies and to be a first-rate steward of the people's money. Plus, speaking out is in the best personal and professional interests of those involved.

The agenda for Monday's meeting contains instructions for participating in the online meeting. Written comments are always useful as well as oral presentations. Written material can provide needed backup for the briefer oral comments and are directly in front of CIRM directors and staff. Comments should be emailed to kmccormack@cirm.ca.gov.

The session starts at 9 a.m. PST Monday. Don't miss an opportunity to help shape the course of California's program to cure untreatable diseases and to lead the way globally on stem cell research. 

California's New Task: A $155 Million Drive to Make Stem Cell Therapies Affordable and Accessible

The enormous cost of stem cell therapies is 
a fresh target for CIRM. 

Proposition 14, California's $5.5 billion stem cell ballot initiative, is coming home to roost, so to speak. 

Next Monday, the governing board of the state stem cell agency is scheduled to begin to settle in under the new measure, which does much more than save the agency's financial life. 

One of the agency's biggest, new challenges involves the accessibility and affordability of the staggering expense of potential stem cell therapies. On the agenda is the creation of a legally mandated "working group" to deal with the treatment cost issues. 

Details of the proposed appointments to the group and its initial steps are not yet available from the California Institute of Regenerative Medicine (CIRM), as the agency is formally known. But the 17,000-word Proposition 14 has plenty to say about the new program. Here is a rundown drawn from my new book, "California's Great Stem Cell Experiment," which deals with the first 16 years of the agency's life, policies and financial times. 

"The new playing field for CIRM encompasses particularly critical areas of costs to patients and profits for companies. Stem cell therapies are expected to be enormously expensive — $1 million or more in many cases. That’s a figure that makes health insurance companies balk and Medicare blanch.

"Proposition 14 would launch a hefty effort to make stem cell therapies more affordable and accessible. The cash behind that drive could run as high as $155 million. And that’s not necessarily going for patients.

"The intent is to create and build support for financial models for health insurance companies. CIRM would also be charged with helping to implement them. Such models would justify the cost of the theoretically one-time cures by demonstrating that they would actually save money — ending the need to treat patients in what currently seems to be an endless and expensive cycle.

"Proposition 14 speaks of covering patients and, importantly, their caregivers for medical expenses, lodging, meals and travel. That would help provide access to clinical trials that are located in prohibitively expensive urban areas, which poses financial barriers for persons who live some distance away. The added coverage would additionally help researchers and companies recruit enough trial participants, which can be a problem in some disease areas.

"The affordability panel would be permitted to operate behind closed doors as it considers the problems and weighs the solutions.

"The extraordinary cost of stem cell treatments involves something called 'reimbursement,' a biomedical industry euphemism for how companies cover the high costs of the research and still make a profit. If money is not to be made, businesses are not likely to be motivated to turn CIRM research into cures.

"Proposition 14 creates a 17-member, CIRM affordability committee to drive all this. It would work with industry and the federal government to win their support. The committee would be backed by as many as 15 CIRM staffers. The ballot allows as much as $55 million for their compensation over 10 or so years.

"But if 15 is not enough, more employees could be hired beyond the nominal cap on CIRM employees of 70 if they are compensated through the use of private cash.

"The measure additionally allows the new affordability panel to hire consultants, capping that expense at about $105 million.

"The affordability effort involves important public policy, industry and research issues that concern patient groups and industry. However, the affordability panel would be permitted to operate behind closed doors as it considers the problems and weighs the solutions.

"Votes by the committee, however, would have to be taken in public.

"Members of the panel would not be required to disclose publicly their economic or professional interests. The committee would be exempt from the state public records act except for material specifically submitted to the CIRM board."

The day-long meeting is open to the public, including scientists, who can also comment and ask questions. Comments are limited to three minutes. Lengthier comments should be emailed to the board via this address: kmccormack@cirm.ca.gov

Complete details on accessing the online meeting can be found on the agenda. 

(See here for a discussion of the $182 million awards program scheduled to be approved on Monday for the first six months of the next year.)

No. 1 Read: A 'Deep Dive' Into the Sweeping Changes Made in California's $12 Billion Stem Cell Program

Capitol Weekly's Twitter item on its most
read story of 2020

Capitol Weekly, the respected online news service devoted to state government and politics, this week reported that its most-read story of the year is an article headlined "Proposition 14: There’s much, much more than meets the eye."

The piece was written by yours truly and dealt with the successful ballot initiative that saved the state stem cell agency from financial oblivion with a $5.5 billion infusion of borrowed money. 

The 17,000-word measure, however, also involved a sweeping expansion of the scope of the agency and made a host of consequential changes. The freelance piece began: 

"Proposition 14, the fall ballot measure to save California’s stem cell agency from financial extinction, contains much, much more than the $5.5 billion that it is seeking from the state’s voters.

"Added to the agency’s charter would be research involving mental health, 'therapy delivery,' personalized medicine and 'aging as a pathology.' That is not to mention a greater emphasis on supporting 'vital research opportunities' that are not stem cell-related.

"The measure would enlarge the board from 29 to 35 members. Even at 29, the board has been much criticized for its large size, which creates more possibilities for conflicts of interest, a long-standing issue for the agency.

"Proposition 14 would ban royalties generated by state-backed stem cell inventions from being used for such things as prisons and schools, isolating the funds from tinkering by lawmakers."

The Aug. 31 article was drawn from my new book, "California's Great Stem Cell Experiment: Inside a $3 Billion Search for Stem Cell Cures."  The book is a product of 15 years of coverage of the stem cell agency and posting of more than 5,000 items on its activities on the California Stem Cell Report.

Other stories in Capitol Weekly's top ten, most-read articles include the governor's plans for a stricter Covid lockdown, the tough sell facing California ballot measures and Capitol Weekly's list of the state's 100, top unelected political power players.

Capitol Weekly has been around for decades, originally as a print publication. It is now part of Open California, a nonprofit that helps to fill a gap left by diminishing coverage of state issues by the mainstream media. 

On its website, Open California says, 

"Our mission is to inform, enlighten and educate Californians about public policy and state governance, and to provide a platform for engagement with public officials, advocates and political interests.  To meet this goal, Open California publishes continuing, in-depth, nonpartisan coverage of current policy and political issues, and hosts regular forums for public discussion of policy and California politics."

Need Work? California's Stem Cell Agency Looking to Hire Ten

Looking for a job with an exciting and unique $12 billion stem cell research funding organization in the Golden State of California.?

The state stem cell agency, which is now into everything from "aging as a pathology" to mental health, is looking to hire 10 persons to fill posts ranging vice president of science to administrative assistant.

While the positions are yet to be officially posted online, here is the list of expected openings, according to the California Institute for Regenerative Medicine (CIRM), as the stem cell agency is officially known. 

(Update: On Jan. 2, applications for seven of these positions were available on the CIRM web site.)

• Senior Executive Assistant
• Senior Science Officer, Review
• Project Manager, Review
• Vice President of Science
• General Counsel
• Grants Management Specialist
• Administrative Assistant
• Director of Finance
• Business Services Officer
• Senior Science Officer

Here is a link to the pay schedule at CIRM. Here is a link to a document dealing with the agency's compensation program as of today.

Official postings for the positions could come as early as late this month. They will appear on this CIRM web page.

CIRM currently has 33 employees. Proposition 14 contains a nominal cap of 70 but also permits the number to grow substantially if the employees are compensated through cash that is not part of the agency's official state bond funding. 

CIRM is currently based in Oakland, Ca. 

California Stem Cell Agency Set to Fund $182 Million in Research in Next Six Months

Click on the above to see a recording of today's online meeting of the CIRM Science Committee

California's newly rejuvenated stem cell program today kicked off its fresh spending plans with a $182 million effort that focuses heavily on awards that could lead more quickly to actual treatments.

The plan was approved by the Science Committee of the governing board of the California Institute for Regenerative Medicine (CIRM), as the $12 billion agency is formally known. CIRM was running out of money until voters this fall approved Proposition 14 and rescued the agency from financial oblivion. 

The $182 million plan for the first half of next year represents CIRM's first major dip into its new, $5.5 billion bucket that was created by narrow voter approval of Proposition 14. The full board is expected to approve the new research budget at its Dec. 21 meeting. 

The program allots $100 million for possibly 10 clinical awards in the next six months. Translational research will receive $60 million (11 awards). "Quest" research is allotted $22 million for 15 awards. Quest awards involve early stage, basic research while translational research involves attempts to move basic research into the clinical level. 

Clinical trials are the last hurdle to clear before a treatment can be approved by the federal government for widespread use. No CIRM-financed stem cell treatments have yet received that approval since the agency began its work 16 years ago. CIRM, however, has helped to fund 68 ongoing clinical trials. 

The Science Committee has 10 members, at least six of whom are linked to institutions or businesses that could apply for CIRM funding.  While members of the 35-member CIRM board can vote on the overall research budget and also "concept" plans for such things as Quest and clinical research, they are barred from voting on specific applications from institutions that they are connected to.  

The Science Committee also approved changes aimed at increasing diversity in CIRM-related research and requiring greater data sharing by scientists. The committee strengthened the staff-proposed diversity language by also proposing scoring applications on how they beef up diversity among researchers. Details on that are yet to be worked out and will be presented to the full board on Dec. 21. 

A call for more diversity among researchers was aired last month at a meeting of the only state entity charged with reviewing CIRM's financial affairs. 

The data-sharing requirement triggered some concern about whether it would be a disincentive to some researchers who feared losing control over their intellectual property.  However, CIRM CEO Maria Millan said the agency was treading carefully to take those concerns into consideration. 

Researchers will be able to apply for the awards shortly after Jan. 1 when detailed program announcements will be released by CIRM. 

Here are links to the changes approved for the Quest program, the translational program and the clinical programs. 

California Stem Cell Agency Beefs Up Budget with Plans to Hire 10 More Persons

The California stem cell agency this morning moved to boost its annual operations budget to $15.3 million, up from the $12.3 million spending plan approved last June. 

The increase came as a result of the passage of Proposition 14, which saved the agency from financial extinction and provides $5.5 billion in state bonds over the next decade or so. The amount brings to $12 billion the expected cost of the agency before it again runs out of cash. 

The 2020-21 budget originally stood at $12.3 million because it anticipated the possible phase-out of the agency, known officially as the California Institute for Regenerative Medicine (CIRM). 

The increases approved today by the CIRM directors' Finance Committee were aimed mainly at hiring additional staff. The agency currently has 33 employees and never has had more than 62. The budget provides for up to 10 new employees, directors were told. 

More are expected to be needed as the agency moves into the new, expanded role authorized by Proposition 14, which provides for more than 85 employees for CIRM.

Other increases were generated by the cost of a triennial, performance audit required by state law, which has run about $230,000, although the audit is barred from evaluating the agency's scientific performance. Legal and related expenses will be increasing by about $318,000. Currently, CIRM has one lawyer on staff with other legal services provided under an outside contract. The general counsel position is vacant. 

Cash for the new budget will come from the agency's existing funds. Proposition 14 funds will not be available until next year. 

(Here are links to today's documents prepared by Jennifer Lewis, acting finance director, dealing with the agency's operational budget: finance presentation, finance appendix.)

The operations budget is relatively minor compared to the amount to be awarded for research grants. That budget is being revised for the first half of next year. The directors Science Committee is scheduled to consider that topic on Friday but has not yet publicly disclosed the staff recommendations. 

(After this item was posted, the stem cell agency added documents to the Friday agenda that dealt with changes in the basic, translational and clinical awards programs, which should be of considerable interest to applicants, among others. See link in the preceding paragraph.)

The Friday meeting is public, as are nearly all CIRM meetings, and can be seen online. The public, including researchers, may comment on each item and address the board as well on any subject at the end of the meeting. 

During the first half of 2021, CIRM directors will be drafting a revised strategic plan that will determine allocations for such areas as basic and translational research and clinical work over the next five years. Also on the table will be a number of new areas for research and significant work on accessibility and affordability issues related to possible stem cell treatments.

The next meeting of the CIRM board is scheduled for Dec. 21 at which it is expected to ratify today's action. 

Vote Count on $5.5 Billion Stem Cell Measure Nearing its Official End

With no votes left uncounted, the ballot initiative that saved the financial life of California's now $12 billion stem cell program has topped out at 51.1 percent approval compared to 48.9 against. 

The count reflects the most recent state election figures from late Friday. None of California's 58 counties is reporting that it has ballots yet to count. 

The raw numbers are 8,588,156 for Proposition 14 and 8,221,692 against. The measure provides $5.5 billion that the state will borrow over the next decade to fund the operations of the California Institute for Regenerative Medicine (CIRM). 

Official certification of the election results is required by Friday.

CIRM was created by another ballot initiative in 2004 with $3 billion in state bonds. That money has nearly run out, and the agency was set to close its doors beginning this month. However, the passage of Proposition 14 saved CIRM. 

The measure provides no additional funding beyond the $5.5 billion. It will run out in 11 or so years, unless the agency slows its expected rate of spending. Because the money is borrowed, interest adds to the cost of the research and to the cost to taxpayers, bringing the estimated total expense to $12 billion. 

8,588,156

51.1%

8,221,692

48.9%

Ties, Politics and Stem Cells: The Becerra Nomination

The Californian who is slated to head the vast federal agency that includes the National Institutes of Health (NIH) and the Federal Drug Administration (FDA)  got his start in politics with the man who is now the vice chair of the California stem cell research program. 

Xavier Becerra
Photo: Lucy Nicholson, Reuters

California Attorney General Xavier Becerra was nominated this week to lead the Department of Health and Human Services after a long career as a congressman and leader of the Democratic Caucus in the House of Representatives.  

Becerra was reared in Sacramento by Mexican immigrants, went off to Stanford as an undergraduate and also received a law degree from the Palo Alto university in 1984. Later, he went to work for then State Sen. Art Torres, now vice chair of the stem cell agency, and in 1986 moved to Los Angeles to direct Torres' district office. Torres, former state Democratic party chairman, and Becerra continue to have close political ties, we understand.

Becerra was elected to the state legislature and Congress with the support of Torres. Becerra served from 1993 to 2017 in the House of Representatives, a period that included top leadership positions. He will have his hands full in Washington. Some Republicans are opposing his nomination because of his stand on abortion and his work on the Affordable Care Act. The Los Angeles Times editorial board labelled Becerra as President-elect Biden's Obamacare "fix-it guy." 

While Becerra's professional life has largely been in politics, he does have a spousal, medical tie. His wife, Carolina Reyes, is a physician, educated at Stanford with an M.D. from Harvard. She is a maternal-fetal medicine specialist, has taught at USC and has been active in a wide range of professional and community activities. Currently she is a member of the governing board of the California Health Care Foundation.

"Reyes is recognized nationwide for her career-long efforts to improve the care of women with high-risk pregnancies — especially those in medically underserved communities," the foundation says. 

The $12 billion state stem cell agency has been working with the NIH and FDA to expedite approval of stem cell therapies that the agency has helped to finance. The agency points to its sickle cell initiative with the NIH as an example of federal-state cooperation. 

Save the Goose: California's Stem Cell Story and the 'Army of 900'

Is the stork bringing stem cell billions?

More post-election coverage is trickling out regarding the activities of the $12 billion California stem cell agency, including a lengthy and compelling piece in the Los Angeles Times, the state's largest circulation newspaper. 

The hitch is that the Times piece does not mention the stem cell agency until the 21st paragraph, a fact that carries more weight than the 40 words in the paragraph itself. 

The article in the Times, written by columnist Sandy Banks, was not really about CIRM per se. But it was a story that might not have been told without a $13 million check from CIRM. 

The piece dealt with sickle cell disease. Banks' entry point was a patient named Evie Junior, whose harrowing experiences are certain to resonate with nearly all the paper's readers. 

Banks wrote,

"As a child, (Junior) grew accustomed to frequent hospital stays. But the disease got progressively worse as he moved through his teens; the bone pain was so disabling, he often had to be sedated with heavy-duty opioids."

Banks continued,

"At one point, the bones in both his legs were so damaged by the disease, doctors thought he might not ever walk normally again. Junior battled back."

Banks wrote,

“'I want to be cured of this disease,' he said. 'And I wish the world was more understanding about the people who are struggling with it.'”

Junior is a patient in a UCLA clinical trial led by Donald Kohn, whose research has been supported by a total of $52 million from the stem cell agency -- a figure not noted in the story. 

The stem cell agency comes into the story ever so briefly at paragraph 21. "The trial is funded by the California Institute for Regenerative Medicine (CIRM), the stem cell agency created by voters in 2004 and infused with $5.5 billion in new research money by voters who narrowly approved Proposition 14 this fall," the Times reported.

That is the first and last mention of California's stem cell program in the Times' story. However, that is better treatment of CIRM than is found in most stories in the media over the last few years -- the ones that deal with accomplishments tied to the agency's cash. (See here and also here.) The articles rarely mention where the money comes from. It could be flown in by stork, for all the readers know. 

Why is this important? The answer has to do with CIRM's reliance on tenuous, ballot-box financing and the sustainability of the California stem cell program.  The situation should be of interest to a little known state entity, which is the only state panel that has a legal charge to review the stem cell program.  

The panel is the Citizens Financial Accountability and Oversight Committee (CFAOC). It was created by the same ballot initiative that established the stem cell agency 16 years ago. Last month, at the CFAOC's once-a-year meeting, its members urged the agency to make itself better known. 

Proposition 14 saved the agency from financial extinction. But the measure was a squeaker, and it set the stage for another life-or-death ballot initiative. The money from Proposition 14 runs out in about 11 years. No other source of funding is provided. If CIRM goes to the ballot again in less than a decade or so, it will need a strong base of support from California voters, 8.2 million of whom voted last month to cut off funding for CIRM.

Building a solid base takes years. It also requires something of a change involving the scientific community and science journalism, which is a big ask. The tradition in scientific journals regarding funding is to relegate mention of the sources of money to a tiny footnote as if it were not the lifeblood of research.

Science writers -- the few that now exist in the mainstream media -- follow that ancient and tired public tradition of ignoring what makes research happen. They focus on "exciting" results from the bench and clinic -- not the "filthy lucre" that pays scientists, their institutions, the post-docs who labor behind the microscopes, the equipment suppliers and keeps the lights on.

Recipient institutions write the news releases -- the starting point for most journalists -- without mentioning the many, many billions that taxpayers (state and federal) have provided. Even the stem cell agency itself does not mention dollar amounts in its blog items dealing with significant results from CIRM research. (For an example, see this item from the agency's blog on the UCLA/Kohn sickle cell trial, which CIRM is funding with $13.1 million. That figure is not directly revealed in the blog item.)

Like most state agencies, CIRM is ignored by the media with only occasional exceptions. Its activities are not well known. That is not likely to change over the next decade despite the best efforts of CIRM's tiny staff. The exception would be a major or even minor scandal or development of a major breakthrough that would resonate with the people of California.

The folks in the media have a vast array of topics to cover, all of which CIRM competes with for attention. The news industry is, in fact, overwhelmed by matters that need public scrutiny: schooling for children, jobs for parents, affordability for housing, vaccines for Covid-19, homelessness, climate change, wildfires and much, much more. Meanwhile, the industry is struggling with its own sustainability issues, laying off thousands of reporters, closing outlets and desperately searching for new business models.

Breaking through this wall of issues to generate favorable, regular coverage of the stem cell agency's good works is a herculean task. And so far, the reality is that CIRM's good works are quite minor in terms of how they affect the lives of the vast majority of the people in California. 

The CIRM team, from top to bottom, has provided a prodigious amount of positive information that can resonate with the public. Building positive relationships with voters, however, is a long-term task that requires commitments that go well beyond CIRM's stalwart staffers, who currently weigh in at only 33 for a multibillion dollar program. 

CIRM has major budget and legal limitations, courtesy of Proposition 14. Its outreach team is small, again an outgrowth of ballot initiatives. Nonetheless, CIRM has a potential army of more than 900 available plus more in the future, given the agency's expansive, new responsibilities authorized by Proposition 14. And that doesn't count the patient advocates or their allied organizations.

The army of 900 consists of the researchers and institutions that have received cash from CIRM -- all potential missionaries who can carry the CIRM message from Yreka in the north to Calexico in the south. 

The institutions could highlight CIRM funding in their news releases, instead of burying or omitting it. Researchers could reach out regularly to the various affected communities to help keep the cash flowing. Grantees could pony up $2,000 each and send it off to a new, broad-based nonprofit that might be called something like "Friends of CIRM."

But more immediately, the army of 900 could -- one by one -- resolve to make six new contacts in 2021 with the public or media to tell the CIRM story. Doing so would serve science and CIRM not to mention themselves.

The next statewide election best suited for approval of another bond measure is fast approaching. It is only eight years away. That is much less time than it takes to complete the preclinical work and clinical trials needed for a federally approved stem cell treatment, which is, ultimately, the only thing that voters really want. 

If the army of 900 needs an inspirational motto, it could be something like "Save The Goose."  You know, the one that lays the Golden Eggs. It is better than relying on the stork. 

Post Election Media on What's Next for $12 Billion California Stem Cell Program

Passage of Proposition 14 has generated a handful of articles recently dealing with the direction of the California stem cell agency over the next decade or so, including pieces carried by Bond Buyer and Calmatters, a respected online news service dealing with state government and politics.

Barbara Feder Ostrov wrote a Nov. 24 article for Calmatters, which quoted  Jonathan Thomas, chair of the California Institute for Regenerative Medicine (CIRM), as saying,

“California has always had a frontier mentality and a love for the cutting edge, and the work that CIRM has done has put it on the very forefront of regenerative medicine.”

Proposition 14 saved CIRM from financial extinction by requiring the state to borrow an additional $5.5 billion for the 16-year-old program, which was originally funded with $3 billion in state bonds in 2004. Total cost of the program is expected to hit about $12 billion before the money runs out again in 10 to 15 years.

Ostrov also quoted Paul Knoepfler, a UC Davis stem cell researcher and blogger, on new areas of research for CIRM that are authorized by Proposition 14. He said,

“Stem cells are interesting and important, but there are going to be a lot of new therapies in the next 10 years that are not stem-cell centric."

In the article, CIRM board member Ysabel Duron addressed the need for improvement of diversity in terms of developing therapies for underserved segments of the population. She said,

“We need to keep researchers’ feet to the fire. They need to show us a plan and we need to reward them.”

Ostrov quoted this writer on some of the issues facing CIRM, including the question of what happens when the latest $5.5 billion is exhausted:

“The sustainability issue is important and it’s hard to address.… The money doesn’t last forever.”

Bond Buyer's Keeley Webster's article noted that the agency will be rewriting its budget now that Proposition 14 has passed. The measure alters CIRM's budgeting rules, shifting some significant costs around. 

Webster quoted state Controller Betty Yee on the agency's $5 million Covid round from last spring. Yee said,

“The $5 million didn’t buy a lot, but it did help get information out to underserved communities. And it put a model out there of how CIRM has been able to accelerate research projects.”

In a piece by Andrew Sheeler, The Sacramento Bee quoted Robert Klein, a Palo real estate developer and sponsor of Proposition 14. Klein poured millions of dollars into the ballot campaign. He said, 

“We had a big obstacle because we had to communicate to voters not only the potential to change the nature of treatments ... but we also had to inform voters of how the state could afford this....It was a citizen’s initiative in the truest sense.”

California's Stem Cell Research Program: How $3 Billion is Growing to $12 Billion

California's 16-year-old stem cell research program is a prodigious enterprise that is helping to finance 68 clinical trials and that has funded hundreds of California scientists for their work in an embryonic field, so to speak. 

The scope and importance of the program and its cost, however, are not necessarily apparent to most Californians. The program is not high on the radar of most people and certainly not the subject of breakfast table conversations in the overwhelming majority of the state's households. 

Over the past 16 years, the California Stem Cell Report has regularly described the stem cell agency, known officially as the California Institute for Regenerative Medicine (CIRM), as a $3 billion effort. But the use of that number did not make it clear that the cost ran significantly higher. 

When CIRM was created through a ballot initiative in 2004, the state Legislative Analyst estimated it could cost taxpayers $6 billion because of the interest on the money that the state borrowed to finance it. The figure has turned out to be closer to $4 billion because of unusually low-interest rates over the last decade or so. 

Under Proposition 14, the agency will receive an additional $5.5 billion from state bonds to spend on research and other new programs. The state legislative analyst has estimated the total cost will run about $7.8 billion because of -- once again -- interest costs. 

The Proposition 14 funding brings the total estimated cost of CIRM to nearly $12 billion.  And that is the figure that the California Stem Cell Report will use going forward to describe the program, unless someone can convince this writer otherwise. 

Referring to CIRM as a $12 billion enterprise immediately tells the reader that it is a significant effort. The number helps to draw readers into stories about CIRM. It is also more accurate than using a smaller figure, which would tend to minimize the cost and mislead taxpayers. Describing CIRM only as a $8.5 billion ($3 billion plus $5.5 billion) agency tends to conceal its true cost to the people of California. (In retrospect, this website should have used the 2004, $6 billion figure to describe CIRM over the last 16 years.)

CIRM is a rare bird among state agencies for a number of reasons. In this case, we know that its funding will cease at some point. Nearly all state departments do not live with that sort of financial guillotine.  

The 17,000-word ballot initiative, crafted by Robert Klein, a Palo Alto real estate developer, limits CIRM's annual CIRM bond sales to $540 million. Based on the experience under the previous initiative -- Proposition 71 of 2004, which created CIRM -- the agency is not likely to hit the $540 million cap each year. That could extend CIRM's possible life for another 15 years or so unless it becomes unusually tight-fisted.

As for the $12 billion figure, this writer is open to arguments for using another number, but I will have to be convinced. I am prepared to air those arguments (their full text) on this website. So if a reader thinks another figure is more appropriate, please let me know the reasons why either by filing a comment using the comment function at the end of this item or by sending me an email at djensen@californiastemcellreport.com.